RELEASE OF STUDENT TO PARENT/GUARDIAN AFTER 
FIELD TRIP OR ACTIVITY

I request that 	_ at Hope Elementary School
Print Student Full Name

be released to my custody after 	on 	_
Trip/Activity	Date

at 	_
Location of Event or Pick-up Point

rather than returning to the school in the transportation provided by Hope Elementary School District.

The following are additionally authorized individuals (also listed on this student’s Emergency Card on file at the school site) to whom the above referenced student may be released:

 	_ 	_
Print Full Name	Daytime Phone Number	Relationship

 	_ 	_
Print Full Name	Daytime Phone Number	Relationship

 	_ 	_
Print Full Name	Daytime Phone Number	Relationship

Waiver of Claims:
I agree that once my son/daughter is released to my custody, I assume full responsibility for his/her health, safety and. I agree to waive all claims against the Hope Elementary School District, its officers, agents and employees, and hold such parties harmless from any and all liability or claims, which may arise out of or in connection with my child’s participation in this activity. This waiver shall not apply to any occurrences which may arise solely out of the negligence of the District, its employees or agents.

 	_
Print Parent/Guardian Full Name	Approval Signature (Parent/Guardian)

 	_	 	
Home Phone Number	Cell Phone Number	Date

It is the responsibility of the designated school administrator to ensure all students are properly accounted for before transportation to or from a school activity occurs.

ALTERNATE TRANSPORTATION OTHER THAN PARENT DISCLOSURE
(Attach this to the approved standard alternate transportation form)

STUDENT NAME:	DATE:  	

TO BE RELEASE TO:   	

EVENT DATE & LOCATION:   	

I understand and acknowledge that athletes are expected to ride the scheduled bus/van to and from the event. Alternate transportation needs to be 48-hour prior approval for parent to transport athlete from the event. Only under extraordinary circumstances can an athlete receive prior authorization from the Principal or Athletic Director to request for alternate transportation from someone other than the parent or officially designated individual on file at school site. Please provide a detailed explanation below.

I understand and acknowledge that in order for someone other than the parent/guardian, I the parent/guardian agree to assume full liability and responsibility for any and all potential risks which may be associated with the named athlete following release to/from the event.

I understand, acknowledge that I the parent/guardian agree to assume full liability and responsibility that the vehicle transporting student-athlete is in good service and safe working order and has the minimum requirements on required automobile insurance.

I understand, acknowledge, and agree that the District, its employees, coaches, or volunteers shall not be liable for any injury/illness suffered by the above-named student-athlete following release to/from the event.

EXPLANATION:

PARENT/GUARDIAN NAME	PARENT/GUARDIAN SIGNATURE

APPROVED BY:   		 	
PRINCIPAL OR ATHLETIC DIRECTOR	DATE